SITUATION ANALYSIS
Virtually all education or outreach programs operational today involve physicians going into developing countries and helping with surgeries or clinical care as volunteers. This approach does not sufficiently empower local doctors and surgeons to establish self-sustaining independent centers. Instead, they remain dependent on visiting doctors from the United States or other developed countries. Most efforts by the AAOS, SRS, and NASS fall into this category. Health Volunteers Overseas represents the largest international medical teaching program with sixty-five programs in twenty-five developing countries. However, only two of their entire sixty-five programs provide any training in spinal care (Wenzhou, China; Managua, Nicaragua). The rest of the developing world is faced with severely limited training opportunities, resulting in a major shortage of trained physicians and access to care. And yet spine disorders are a critical public health problem for emerging economies because they are the number one cause of impairment and disability among working aged people (18-55).
Spinal disease requires a specialized level of knowledge and training to allow safe, effective and affordable care. However, in the majority of cases, a sound knowledge of basic core techniques is sufficient to provide excellent spine treatment, even with limited resources. Fundamentals are the essential. It is not necessary that the very latest, demanding and most expensive techniques always be available. Physicians in the developing world often have no real opportunity for even this fundamental level of spine education and surgical training. Furthermore experienced surgeons are not available to serve as mentors to younger developing doctors. Finally, any efforts to address this problem require sensitivity to unique local circumstances and to the wide range of socioeconomic realities present in each country.
Why China? China has very unique opportunities and challenges in health care at this moment in history. In some areas of the country health care is as sophisticated and technologically advanced as anywhere in the world. However, these facilities are few, and the number of physicians with advanced knowledge and experience pale in comparison to the potential demand. Although average per capita income is only $3400/year, there is a rapidly growing middle class who seek out high quality health care and millions of others with no care at all. Simultaneously, urbanization is progressing so fast that 2/3 of the 1.4 billion Chinese will be city dwellers by 2020. This urbanization means better access and proximity to hospitals and clinics for many who need care. The challenge is to provide enough well trained physicians to serve these large populations.
Unfortunately, the training of physicians in China is lagging behind today's rapid urbanization and growth. During the Mao years, medical school faculty members were sent away for reeducation, and the program of Barefoot Doctors took their place. Universities and hospitals deteriorated, and decades passed where there were very few newly trained physicians. The loss of the older experienced generation, together with the gap of 20-30 years without a new generation of trained doctors combines to create a unique situation today. There are inadequate numbers of senior physicians to help teach and mentor the recently re-emerging young generation of doctors. Furthermore, the lack of continuity in medical training has also resulted in a widespread lack of standardization. The ingredients of core knowledge and competency in spine care have not been established in China, resulting in additional gaps in education, experience, and quality of care country-wide. This interplay between the growing middle class (300-600 million people which creates demand for health care), urbanization and the inadequate capacity to provide enough experienced physicians today means China has a unique requirement for seasoned mentors and a standardized educational experience for the emerging generation of physicians.
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